Title: Additional Assessment Considerations
1Additional Assessment Considerations
- Advanced Health Assessment
- Lesson 2
2Review Items
- Topics listed are for general review purposes
to serve as a reminder that each of these
components are significant aspects of the
assessment. - Notes included in pediatric growth development
notes include lifespan family dynamics
information also
3Relevant Topics
- Assessment across the lifespan
- Family Assessment
- Cultural Assessment
- Nutritional Assessment
- Sleep Assessment
- Sexual Assessment
- Vital Signs Lab Values
4Assessment Across the Lifespan
- Ericksons psychosocial theory of development
serves as an excellent framework - Other theories are addressed for pediatrics in
the handout
5General guidelines for Dealing with Children
- Infants
- Young Child
- School Age Child
- Adolescent
6General Guidelines for Dealing with Adults
- Young Adult
- Middle Age Adult
- Aging Adult
7Family Assessment
- The family can be assessed in a variety of ways
- Biologic
- Economic
- Educational
- Psychological
- Sociocultural
8Family Definition
- Any group of people related biologically,
emotionally or legally. - Its function is to help its family members
satisfy their needs for physical emotional
survival
9Family Provides for its Members
- Esteem
- Relief
- Buffering mediation
- Emotional life bonding force
- Support system for meeting basic needs
- Raising of children, preparing for adulthood
10Family Function Coping
- Family Strengths
- Family Coping Success
- Meeting Developmental Tasks
11Basic Areas of Family Assessment
- Structure Composition significant influences
- Family Function How families interact
12Family Composition
- Nuclear
- Nuclear Dyad
- Kin Network (Extended Family)
- Single Parent
- Blended (Reconstituted)
- Binuclear (Joint Custody of Children)
13Family Composition
- Homosexual
- 3-Generation
- Co-Habitating Couples
- Single Adult (Living Alone)
14Significant Family Influences
- Home Conditions Community Environment
- Occupation Education of Family Members
- Cultural Religious Traditions
15Family Functional Assessment
- Family Interactions Roles
- Power, Decision Making Problem Solving
- Communication
- Expression of Feelings Individuality
16Theoretical Framework for Evaluating Families
- Systems Theory
- Development Theory
- Structural-Functional
- Interactional
17Strong Families
- Sense of Commitment
- Sharing Traditions
- Active Expression of Appreciation
- Effective Communication
- Spending Time Together
18Strong Families
- Shared Values
- Solving Problems Coping
- Sense of Humor
19Difficult Family Issues
- Missing support the less support, the more
morbidity - Enmeshment - Disengagement
- If connected by strong emotion, may resist change
in roles behaviors of individuals - Change is disequalibriating disquieting
20Difficult Family Issues
- Paying attention to how change affects the family
is better tolerated - Conflict arises when emotions attitudes are too
far out of synchrony - Needs unmet dissatisfactions arise
21Some Common Family Conflicts
- Dominance vs. Submission
- Closeness vs. Autonomy
- Emotion vs. rationality
- Over involvement vs. distancing
- Health vs. Disease
22Common Family Conflicts
- Adequacy vs. Mismanagement
- Responsibility vs. irresponsibility
- Sharing vs. Nonsharing
23Common Psychosocial Problems
- Domestic conflict sexual difficulties
- Substance abuse dependence
- Domestic violence
- Physical, emotional or sexual abuse of women
children - Divorce
- Financial management - mismanagement
24Cultural Assessment
- Culture
- Subculture
- Race
- Ethnic Group
- Minority Group
- Customs Rituals
- Values Cultural Norms
25Values Affecting Health Care
- Time Orientation
- Activity Orientation
- Human Nature Orientations
- Human-Nature Orientation
- Relational Orientations
26Beliefs Practices
- Folk Illness
- Naturalistic Illness
- Personalistic Illness
- Specific Practices
27Some Specific Issues
- Coining or Moxa
- Distant vs. close space
- Eye contact (direct or indirect)
- Family Authority
- Dietary Customs
- Ethnic Predisposition to illness
28Nutritional Assessment
- Major component of health maintenance
- Identify nutritional risk
- Over nutrition
- Under nutrition
29Nutritional Screening
- Health history
- Lifestyle habits, food choices exercise
- Medications supplements
- Diet History
- 24 hour diet re-call
- 3-4 day food recall records
- food frequency questionnaires (6 months)
30Comprehensive Nutritional Screening
- Weight is lt80 or 120 of ideal weight
- Unintended weight loss of gt4.5kg
- Low serum albumin level
- Low total lymphocyte count
- History or physical exam indications
31Subjective History Information
- Unusual weight changes
- Changes in appetite, taste, smell, dentition,
chewing, swallowing - Recent illness, surgery, trauma, burns,
infection, chronic illness - Vomiting, diarrhea, constipation
- Food allergies or intolerances
32Diet Evaluation Comparisons
- Food Pyramid 6 food groups
- Guideline 5 servings or fruits or vegetables per
day
33Age Related Considerations
- Infants
- Young Children
- Adolescents
- Pregnancy Breast Feeding Female
- Older Adult
34Objective Data Clinical Assessment
- Skin, Hair Nails
- Mouth
- Musculoskeletal System
- Cardiovascular System
- Gastrointestinal System
- Neurological System
35Body Measurements
- Height
- Weight
- BMI Nomogram
- Skin Fold Thickness (TSF)
- Mid-upper arm circumference
- Waist-to-hip ratio
36Laboratory Studies
- Hemoglobin Hematocrit
- Total Lymphocyte Count
- Serum Albumin
- Fasting Blood Sugar
- Serum Lipids
37Sleep Assessment
- Sleep has restorative function
- Sleep deprivation may cause changes in mood
performance fatigue, irritability, anxiety,
depression, feelings of persecution, poor
concentration, feelings of depersonalization
increased aggression
38Sleep Assessment
- Identify Sleep Problems
- Evaluate quantity quality of sleep
- Identify circumstances that promote or inhibit
sleep - Identify psychological or physiological factors
affecting sleep
39Sleep Categories
- Non-REM Non rapid eye movement sleep, consisting
of 4 stages, during which no dreaming occurs - REM Rapid eye movement sleep, during which
dreaming occurs - Both types of sleep occur during the 4-6 cycles
of sleep occurring during an8-hour sleep period
40Sleep Patterns with AgeHours of Sleep per Day
- Infants 14-18
- Young Children 10-14
- Older Children 8-10
- Adolescents Increase
- Adults 7-9
- Older Adults Awake frequently, nap
41Common Sleep Problems
- Sleep Apnea
- Insomnia
- Sleepwalking
- Sleep terrors
- Nocturnal enuresis
42Sexual Assessment
- Interviewers personal attitudes important
- Issues different in various age groups
- Straight forward approach useful
- Chronic illness influence
- Advancing age